Wednesday, January 24, 2007

tooth ordeal, volume 3

Jacob had the first of his two cavities filled today. We of course had already decided to go with the composite, although it DEFINITELY made it much more of an ordeal for him than it would have with the amalgam. (Still and all, I'd rather preserve his overall health than save him a bit of short-term trauma, so I'm still very happy with our decision on this.) He had to have 3 rounds of grinding/polishing that he wouldn't have had to have with amalgam (the dentist would have just drilled, and stuffed the amalgam in there).

As I've mentioned previously, this is a pediatric practice, with a dentist that has an actual Autism protocol for dealing with Autistic patients. They've build up his trust over a series of visits, as well as introducing him to all the equiptment they might possibly have to use on him. He LOVES these people, and we're always sure to arrange appointments so that the same Hygienist is working on him as well as his "friend" the dentist. This dentist happens to have an adult son who is Autistic, so his mannerism with Jacob is the sort he only gets from parents of other Spectrum kids -- pretty much 100% appropriate, and never taking Jacob's good mood at the moment as an indication of him being able to handle things in the same way a neuro-typical kid would. He always assumes that the least little thing might set Jacob off, so he does a lot of pro-active work to prepare him for each thing, and has back-up plans on what to do if things go awry.

That might make it easier for folks to understand why I trust these folks completely, and willingly go along with their request that I do NOT accompany Jacob back into their work area. (Of course, I did, at their request, the first couple of visits until Jacob learned to trust them.) I can hear everything going on, and can peek around the corner when I feel I need to, but I'm out of Jacob's vision for the entire thing. I know that they are experts with this sort of thing, so I happily leave it in their capable hands. It's always worked well for Jacob before, and it seemed to work well this time too. I really think if I was there, he'd be trying to crawl out of that chair for me to "rescue" him.

This dentist is also a big believer in NOT using anesthesia in the office. He doesn't take chances with kids' lives, and I 100% support that. So many people have reccommended that I find a dentist that uses laughing gas, but for the same reason I don't want mercury in his teeth, I don't want drugs in his lungs/brain. Of course I agreed to novacaine, but I was very happy that he was insistant on do this without giving Jacob anything stronger. (This is also the reason I so seriously considered his offer to put in amalgam fillings -- he wouldn't have reccommended this if he wasn't so sure that it was a viable option for reducing Jacob's trauma.)

Here's the details on how the visit went:

We walked in at our appointment time (actually, Jacob SKIPPED in), and Jacob sat in a chair waiting to go see his friends, more interested in interacting with them than in playing with the toys. (WOW, how far we've come with EVERYTHING!) When his Hygienist appeared, he squealed with glee and dashed over to take her hand and have her lead him into the back. (That made my heart skip a beat, actually, knowing what was to come....I'm guessing he won't be that happy to see her next time.) I could hear them making chit chat with him as they got him situated at the work station. Before they got started, the dentist paid me a quick visit to confirm what was going to happen with me, and commented on Jacob's great mood today.

The first thing I heard from the back was the dentist explaining some of the equiptment they were putting on Jacob, and then I heard him say "Jacob, this is going to be a little pinch" as he apparently shot in the novacaine. When I didn't hear any screaming or crying, I sank back in relief in my seat. They chatted quite awhile about various kid type stuff while the novacaine was taking effect. I actually picked up a magazine and started glancing through it.

Then he turned the drill on.

Immediately I could hear sounds of distress coming from Jacob. There was groaning, crying, a little screaming, and a very clear declaration of "that's SCARY!" I could hear the staff reassuring Jacob that all was well and praising him for holding still. I could hear him begging for it to be done. I was half aware of the magazine slipping off my lap onto the floor as I perched on the edge of my seat, waiting to run to my boy's rescue. But in a few minutes, the drilling was done. I could hear lots of praise, Jacob's crying and noises stopped, and in a few minutes his voice returned to normal and resumed chatting with everyone while they prepared the composite material. I released my death-grip on the arms of my chair and sagged back in the seat, heart still pounding. I listened while the dentist explained the stuff he was doing while filling the teeth, the special light used to make it hard, etc. And then he explained that he was going to file it and make it shiny.

Jacob must have seen him pick up the tool again, because I heard the shout "OH NO! NOT THAT AGAIN!" in a panicked tone. The dentist talked him through it, Jacob continued to beg for it all to end. No screaming this time, more of a resigned-to-this-torture type of thing. This was the procedure that we could have avoided with the amalgam. But like I said, even though it pretty much tripled his torture time, I couldn't have lived with myself if I'd let him put mercury in my kid's head. So I just bit my lip and choked back my tears, and busied myself tidying up the magazine rack.

The dentist came out while the staff was cleaning him up, and sang Jacob's praises -- he said that despite his protests and unhappiness with the procedure, Jacob kept his mouth open the entire time, and they didn't need to use the bite block at all. He never tried to climb out of the chair, and the few times he tried moving, he settled back down when they asked him to hold still. He rated it as a completely successful visit. At about that time, Jacob came down the hall and into my arms, then directly to the coat rack where he hurriedly put on his outerwear, blinking back tears, avoiding looking at anyone. I set up another appointment in a few weeks, and they warned me about his cheek being numb for the next hour or so (next time will be worse, as it's a bottom tooth and they'll have to numb his entire jaw on that side). We'll see how successful I am at getting him through those doors again....

Fortunately, while I was making the appointment and Jacob was trying to leave, another little boy and his mom came in. Jacob immediately turned into host, and showed the little boy all the toys in the waiting room. Then he got caught up in playing along with him, so I sank into a chair and let him have some relaxed time, reminding him gently about not chewing on his cheek when it looked like he might be. When the hygienist showed up for the little boy, Jacob introduced her "I'd like you to meet my friend, D.". She thanked Jacob and took the little boy down the hall, and Jacob said he was ready to go home. (Well, back to his grandparent's house, where Zoo Boy was waiting and playing -- they had a great time tossing Jacob's new foam airplane -- his "prize" from the dentist for being so good -- with their Grandpa.)

So, we survived! I'm actually very pleased with how it all went, really best case scenario. I'm pretty worried about getting him in for the next appointment, and I'm REALLY interested to see what he has to say about it to The Map Man when he gets home from work. But I'm less scared about the actual procedure being done again. I think we're both going to live through it.


At 7:23 PM, Anonymous Anonymous said...

I was so relieved to read your account I almost cried.

At 8:38 AM, Anonymous kyra said...

WOW! YAY! that is so fantastic! this practice sounds absolutely amazing and i'm SOOOOO proud of jacob! and you!


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